Home Ventilation in Children

Introduction: Home mechanical ventilation (HMV) can prolong survival and improve quality of life. The objectives were to review the challenges, clinical conditions and outcome of children who were discharged from the hospital on respiratory support.Material and Methods: Twenty four patients, who were electively discharged from PICU and had received home ventilatory support for more than 15 days, were enrolled over 11 year study period. Patients were followed up monthly, for two years, for ventilatory requirements, any problems encountered during previous month and for any complication.Results: Twenty four patients with a median age of 3.5 years were discharged home with ventilatory support. HMV was started in 2001 at our hospital. Patents received home ventilation for a median period 5.4 months. Twenty (83.3%) patients received invasive mechanical ventilation via tracheostomy and four (16.7%) patients received non-invasive mechanical ventilation. Twelve (50%) patients received ventilatory support for more than 20 hrs a day and twelve (50%) patients received only during sleep. On follow up for two years for each patient, twenty (83.3%) patients successfully came off from ventilatory support while, two (8.3%) patients died and two (8.3%) lost to follow-up.Conclusion: HMV can be safely applied in selected children with CRF after providing adequate training to the care givers. For its more efficient use, we need to have good social support and medical assistance which can be extended to their homes to meet their complete health care needs.J Nepal Paediatr Soc 2015;35(1):85-88

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Non invasive mechanical ventilation in myotonic dystrophy type 1? Hypoventilation versus quality of life perspective

Neuromuscular Disorders ◽

10.1016/j.nmd.2017.11.019 ◽

2018 ◽

Vol 28 (2) ◽

pp. 193

Author(s):

Giuseppe Fiorentino ◽

Antonio M. Esquinas

Keyword(s):

Quality Of Life ◽

Mechanical Ventilation ◽

Myotonic Dystrophy ◽

Invasive Mechanical Ventilation ◽

Myotonic Dystrophy Type 1 ◽

Myotonic Dystrophy Type ◽

Non Invasive

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Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05692-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tommaso Tonetti ◽

Lara Pisani ◽

Irene Cavalli ◽

Maria Laura Vega ◽

Elisa Maietti ◽

...

Keyword(s):

Mechanical Ventilation ◽

Controlled Trial ◽

Invasive Mechanical Ventilation ◽

Chronic Obstructive ◽

Invasive Ventilation ◽

Obstructive Pulmonary Disease ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Acute Exacerbations

Abstract Background Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial. Methods multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality. Discussion Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD. Trial registration ClinicalTrials.gov, NCT04582799. Registered 12 October 2020, .

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Factors associated with non-invasive mechanical ventilation failure in patients with hematological neoplasia and their association with outcomes

Journal of Intensive Care ◽

10.1186/s40560-020-00484-x ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Lídia Miranda Barreto ◽

◽

Cecilia Gómez Ravetti ◽

Thiago Bragança Athaíde ◽

Renan Detoffol Bragança ◽

...

Keyword(s):

Mechanical Ventilation ◽

Clinical Judgment ◽

Oxygen Therapy ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Orotracheal Intubation ◽

Icu Mortality ◽

Factors Associated ◽

Non Invasive ◽

Ventilation Failure

Abstract Background The usefulness of non-invasive mechanical ventilation (NIMV) in oncohematological patients is still a matter of debate. Aim To analyze the rate of noninvasive ventilation failure and the main characteristics associated with this endpoint in oncohematological patients with acute respiratory failure (ARF). Methods A ventilatory support protocol was developed and implemented before the onset of the study. According to the PaO2/FiO2 (P/F) ratio and clinical judgment, patients received supplementary oxygen therapy, NIMV, or invasive mechanical ventilation (IMV). Results Eighty-two patients were included, average age between 52.1 ± 16 years old; 44 (53.6%) were male. The tested protocol was followed in 95.1% of cases. Six patients (7.3%) received IMV, 59 (89.7%) received NIMV, and 17 (20.7%) received oxygen therapy. ICU mortality rates were significantly higher in the IMV (83.3%) than in the NIMV (49.2%) and oxygen therapy (5.9%) groups (P < 0.001). Among the 59 patients who initially received NIMV, 30 (50.8%) had to eventually be intubated. Higher SOFA score at baseline (1.35 [95% CI = 1.12–2.10], P = 0.007), higher respiratory rate (RR) (1.10 [95% CI = 1.00–1.22], P = 0.048), and sepsis on admission (16.9 [95% CI = 1.93–149.26], P = 0.011) were independently associated with the need of orotracheal intubation among patients initially treated with NIMV. Moreover, NIMV failure was independently associated with ICU (P < 0.001) and hospital mortality (P = 0.049), and mortality between 6 months and 1 year (P < 0.001). Conclusion The implementation of a NIMV protocol is feasible in patients with hematological neoplasia admitted to the ICU, even though its benefits still remain to be demonstrated. NIMV failure was associated with higher SOFA and RR and more frequent sepsis, and it was also related to poor prognosis.

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Trends in the Use and Outcomes of Mechanical Ventilation among Patients Hospitalized with Acute Exacerbations of COPD in Spain, 2001 to 2015

Journal of Clinical Medicine ◽

10.3390/jcm8101621 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1621 ◽

Cited By ~ 2

Author(s):

de Miguel-Diez ◽

Jiménez-García ◽

Hernández-Barrera ◽

Puente-Maestu ◽

Girón-Matute ◽

...

Keyword(s):

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Ventilatory Support ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Acute Exacerbations ◽

Discharge Database ◽

Over Time

(1) Background: We examine trends (2001–2015) in the use of non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) among patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). (2) Methods: Observational retrospective epidemiological study, using the Spanish National Hospital Discharge Database. (3) Results: We included 1,431,935 hospitalizations (aged ≥40 years) with an AE-COPD. NIV use increased significantly, from 1.82% in 2001–2003 to 8.52% in 2013–2015, while IMV utilization decreased significantly, from 1.39% in 2001–2003 to 0.67% in 2013–2015. The use of NIV + invasive mechanical ventilation (IMV) rose significantly over time (from 0.17% to 0.42%). Despite the worsening of clinical profile of patients, length of stay decreased significantly over time in all types of ventilation. Patients who received only IMV had the highest in-hospital mortality (IHM) (32.63%). IHM decreased significantly in patients with NIV + IMV, but it remained stable in those receiving isolated NIV and isolated IMV. Factors associated with use of any type of ventilatory support included female sex, lower age, and higher comorbidity. (4) Conclusions: We found an increase in NIV use and a decline in IMV utilization to treat AE-COPD among hospitalized patients. The IHM decreased significantly over time in patients who received NIV + IMV, but it remained stable in patients who received NIV or IMV in isolation

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Non-invasive mechanical ventilation in myotonic dystrophy type 1? Hypoventilation versus quality of life perspective

Neuromuscular Disorders ◽

10.1016/j.nmd.2017.12.004 ◽

2018 ◽

Vol 28 (2) ◽

pp. 194 ◽

Cited By ~ 1

Author(s):

Ghilas Boussaid ◽

Frédéric Lofaso ◽

David Orlikowski ◽

Dante Santos Brasil ◽

Stéphane Bahrami ◽

...

Keyword(s):

Quality Of Life ◽

Mechanical Ventilation ◽

Myotonic Dystrophy ◽

Invasive Mechanical Ventilation ◽

Myotonic Dystrophy Type 1 ◽

Myotonic Dystrophy Type ◽

Non Invasive

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Recurrence plots for dynamical analysis of non-invasive mechanical ventilation

Philosophical Transactions of The Royal Society A Mathematical Physical and Engineering Sciences ◽

10.1098/rsta.2007.2114 ◽

2007 ◽

Vol 366 (1865) ◽

pp. 621-634 ◽

Cited By ~ 6

Author(s):

C Letellier ◽

H Rabarimanantsoa ◽

L Achour ◽

A Cuvelier ◽

J.-F Muir

Keyword(s):

Mechanical Ventilation ◽

Shannon Entropy ◽

Invasive Mechanical Ventilation ◽

Chaotic Regime ◽

High Rate ◽

Dynamical Analysis ◽

Recurrence Plots ◽

Chronic Respiratory Diseases ◽

Non Invasive

Quantifiers were introduced to convert recurrence plots into a statistical analysis of dynamical properties. It is shown that the Shannon entropy, if properly computed, increases as the chaotic regime is developed as expected. Recurrence plots and a new estimator for the Shannon entropy are then used to identify asynchronisms in non-invasive mechanical ventilation. It is thus shown that the phase coherence—easily identified using a Shannon entropy—is relevant in the quality of the mechanical ventilation. In particular, some patients with chronic respiratory diseases or healthy subjects can have a high rate of asynchronisms but a regular breathing rhythm.

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